Provider Demographics
NPI:1407871221
Name:HOOVER, SUSAN JANE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JANE
Other - Last Name:RAZZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27814 WALSH CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1748
Mailing Address - Country:US
Mailing Address - Phone:832-454-1873
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:UNIT 1407
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:281-566-1923
Practice Address - Fax:713-745-5565
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91531208600000X
TN42821208600000X
TXK27172086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271032300Medicaid
FL50740OtherBLUE CROSS BLUE SHIELD
FL50740ZMedicare ID - Type Unspecified
FLH46102Medicare UPIN
FL271032300Medicaid